Rate of avascular necrosis and time to surgery in proximal humerus fractures

PURPOSE

Avascular necrosis (AVN) of the humeral head is a devastating complication of proximal humeral fracture (PHF) that often results in long-term morbidity for the patient. Rates of AVN depend on the number of fracture fragments and are highly variable. The literature suggests that timely stable and anatomic reduction may decrease the rate at which AVN develops after PHF. To our knowledge, there is no literature published investigating a temporal relationship between the timing of PHF fixation and rates of AVN.

METHODS

Operative records of one orthopedic trauma surgeon were used to identify patients that underwent open reduction internal fixation for PHF at our institution between 2007 and 2012. Radiographs at presentation were reviewed and used to classify the fractures into two, three or four parts. Date and time of the initial radiograph were recorded as were the date and time of available intra-operative fluoroscopic images. The time from presentation radiograph to operative fixation was calculated (hours). Available follow-up plain films were then reviewed and evaluated for the presence or absence of humeral head AVN.

RESULTS

Time to surgery (less than or greater than 72 h) and patient age did not correlate with development of AVN after PHF (p > 0.26). Notably, the number of fracture fragments did influence the rate of AVN identified in patients with PHF (p = 0.002).

CONCLUSION

Early operative intervention does not appear to decrease the rate of development of avascular necrosis after PHF.

The rechargeable aluminum-ion battery

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Nuclear factor kappaB p65 phosphorylation in orthodontic tooth movement

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Surface-functionalized nanoparticles with liquid-like behavior: the role of the constituent components

Ionically modified silica nanoparticles with large counter anions (sulfonate, isostearate) at two silica volume fractions (13 and 27%) form a viscous fluid and a glass but not crystalline solids. Dielectric spectroscopy, Brillouin scattering and shear rheometry were employed to investigate these new nanoparticle-based fluids. The glass transition temperature and hence the local dynamics are governed by the large counter anions, whereas the flow properties can be controlled by the spatial correlation between the nanoparticles, e.g. by tuning the volume fraction of hard cores and local interactions between segments in the soft corona. Liquid-like ordering of the cores was revealed by X-ray scattering and found to influence significantly the macroscopic flow properties of these salts.

Empowering women in a violent society. Role of the family physician

Despite erosion of key societal institutions, family physicians have remained a focal point for many troubled individuals--particularly women. The prevalence and types of abuse women experience and the effects on women's lives are summarized. Disclosures of abuse can affect family physicians. Increased awareness of gender role socialization messages for women is also relevant to family practice.

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Assessment and treatment of food aversion in a four year old boy: a multidimensional approach

Eating and mealtime problems are common in childhood. They are often stressful not only to the child, but to the entire family. In this case report we describe a multidimensional approach to the assessment and treatment of food aversion in a four year old boy. The integration of psychodynamic, systemic and behavioural concepts in the assessment and treatment is described. In addition we report on preliminary findings from the Children's Eating Behaviour Inventory, a new instrument under development, intended to assess eating and mealtime problems in children.

Blissymbolics-a nonverbal communication system

Until recently, speech-language pathologists have shown little interest in seeking alternate forms of communication when functional verbal communication is not attainable. There is a paucity of literature dealing with nonverbal communication systems for people lacking functional verbal communication for reasons other than deafness. Blissymbolics is a logical, visual language that has provided functional communication for nonverbal cerebral-palsied children. The full potential and application of Blissymbolics has only begun to be realized, and there is much need for experimentation and research. This paper describes the system and suggests areas for future application and development.